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@c729 -- I'm pretty sure tramadol does not show up on a standard urine screening. Vistaril is actually an antihistamine, but is prescribed for anxiety sometimes. Benzos will definitely show up, so if you don't have a prescription for those, you will have a problem.

@crucibelle You're absolutely right, tramadol will not show up on a typical standard urine immunoassay (i.e.- an onsite test cup). Because most are cheap 5-panel tests.

However, I suspect that a 12-panel test might show it. Why? Because. Because why? Because a 12-panel gold standard test cup such as an Amedicheck tests for tca (tricyclic antidepressants) such as doxepin and clomipramine, which is useful for psychiatrists who want to learn if patients are taking their psych meds or not. I do not take any class of tricyclic antidepressants. So when I self-test with an Amedicheck 12-panel, as i did today, it should show negative for TCA's. But it does NOT! It shows positive! Why? No idea. Only thing I can think of, is that I take citalopram (celexa), which is an SSRI. It prevents re-uptake of serotonin, so the elevated levels of serotonin might theoretically trigger a TCA as positive. If that's the case, then tramadol might trigger a TCA positive, because tramadol is serotonin and norepinephrine re-uptake inhibitor, albeit a much weaker one than the typical antidepressant.

So as long as you're not given a 12-panel test, you should be fine. Probation offices, many employers, use simple 5-panel. Pain clinics, psychiatric offices, high security clearance employers, things like that, are more likely to use more sophisticated methods of testing.

As always, as a disclaimer, gc/ms lab testing confirms every drug in the system. And hair follicle confirms every drug used in at least the previous 3-4 months.

I took my first drug test at my doc's office yesterday and I'm concerned.,

I was very sick with phnomia(sp), cause when I'm upset or stressed I lose my spelling. I need my meds to show! I went to the bathroom before I left. Didn't know this was comiing and I have a nervous bladder. I couldn't pee to save myself. I drank water while my dd and I did our office visit. During the visit the Dr asked my daughter why she didn't have vicodin in her sample. She took her normal dose 3 hrs before the appt, and was confused. She showed him her daily dose box to prove she took all her 8:30 am meds. He said oh it would probably show up in her lab test.

Here am I trying to go, and finding out the tests might not work right. I am a chronic pain patient as well as her. We are both treated for panic attacks plus she is treated for bi-polar disorder, adhd and ocd. We don't share meds and I take percocet instead of hydrocodone. The only drugs we take that are the same are xanax, and soma. I tried to go again, and then tried the salava test and my mouth was dry as a bone because of all the meds I take.

I came back 2 hrs later and managed to barely get enough in the cup as my hand was shaking and had more on my hand than the cup and I was coughing very bad.

So, my ds took one last week and his meds didn't show up and he is in trouble.

See where I'm going here. I don't trust their lab. I didn't give a good sample and I'm sick. This man has been our family dr for 20 years. His whole career. I don't want to lose him.

Tox Screens

Originally Posted by crucibelle

@c729 -- I'm pretty sure tramadol does not show up on a standard urine screening. Vistaril is actually an antihistamine, but is prescribed for anxiety sometimes. Benzos will definitely show up, so if you don't have a prescription for those, you will have a problem.

I want to preface this by saying that I am not a toxicology expert by any means, but I'm an ER nurse and have some extensive experience with tox screens, both urine and blood.

First, Tramadol, while labeled non-narcotic is an opiate derivative, and can show up as positive for opiates. Vistaril has been known to show up as a benzo, even though you are correct, it is an antihistamine.

Someone asked a question previously about poppy seeds. While poppy seeds sometimes show up as opiates, it can be determined that it was from eating a poppy seed bagel, for example, based on the level. So if you're taking opiate-based pain meds, test positive for opiates and try to say it was just a poppy seed bagel, they're not going to buy it.

Most drug screens now test for things like golden seal and other detox drinks, so I would stay away from them. In the ER when we do a drug screen, we fill out the paper work and have to check off the box that says "test for adulterants." So the labs are testing for that regularly now.

With regard to the synthetic urine, it's really not a good idea. There's a part of a urine test that tests for something call specific gravity. Synthetic urine doesn't have the correct levels. Synthetic also does not have the appropriate levels of creatinine in it. If you need to use urine that is not your own for a drug screen, I recommend using real human urine. There are websites you can buy it from that are reputable, or you could just use a friend's urine who you know is clean. As far as temperature goes, urine comes out at human body temperature, so you aiming for 95-99 degrees. Warm water from a faucet is not warm enough.

On a side note, there are many, many OTC meds that can cause false positives for some pretty serious drugs on a tox screen. For example, Immodium can cause a false positive for methadone, as it is a synthetic opiate derivative. Also, many people are screened for alcohol. They now test for liver metabolites in the urine that are produced by the liver when breaking down alcohol for excretion. So you may not have had a drink for 5 days, but they will still be able to tell that you drank recently.

There are ways to pass even an observed urine screen, however, this is much easier for females than for males. The people that do the urine observations are onto the whizzinator. They see them all the time. It's easier for women because we can store it internally, which makes it the correct temperature and harder for the observer to see. I hope this helps. If anyone has any questions, I will try my best to give the most accurate information available.

somebody please respond to my question about dr office test?

I want all the meds I take to show up! I do take a GI Cocktail with Malox, donatol, and lidocane. It dries my mouth and causes urine problems. I drink a gallon a day of water. I take my narcotic meds, muscle relaxers, benzos, sleeping pills, and GI meds besides the cocktail. I am worried because my test was piss poor, and wonder if I should offer to take another or just wait till the call me? Can Lab tests just be faulty?

I don't understand why my daughter's vicodin didn't show with the dip test when she took it 2 hrs not 3 before the test?

I want to preface this by saying that I am not a toxicology expert by any means, but I'm an ER nurse and have some extensive experience with tox screens, both urine and blood.

First, Tramadol, while labeled non-narcotic is an opiate derivative, and can show up as positive for opiates. Vistaril has been known to show up as a benzo, even though you are correct, it is an antihistamine.

Someone asked a question previously about poppy seeds. While poppy seeds sometimes show up as opiates, it can be determined that it was from eating a poppy seed bagel, for example, based on the level. So if you're taking opiate-based pain meds, test positive for opiates and try to say it was just a poppy seed bagel, they're not going to buy it.

Most drug screens now test for things like golden seal and other detox drinks, so I would stay away from them. In the ER when we do a drug screen, we fill out the paper work and have to check off the box that says "test for adulterants." So the labs are testing for that regularly now.

With regard to the synthetic urine, it's really not a good idea. There's a part of a urine test that tests for something call specific gravity. Synthetic urine doesn't have the correct levels. Synthetic also does not have the appropriate levels of creatinine in it. If you need to use urine that is not your own for a drug screen, I recommend using real human urine. There are websites you can buy it from that are reputable, or you could just use a friend's urine who you know is clean. As far as temperature goes, urine comes out at human body temperature, so you aiming for 95-99 degrees. Warm water from a faucet is not warm enough.

On a side note, there are many, many OTC meds that can cause false positives for some pretty serious drugs on a tox screen. For example, Immodium can cause a false positive for methadone, as it is a synthetic opiate derivative. Also, many people are screened for alcohol. They now test for liver metabolites in the urine that are produced by the liver when breaking down alcohol for excretion. So you may not have had a drink for 5 days, but they will still be able to tell that you drank recently.

There are ways to pass even an observed urine screen, however, this is much easier for females than for males. The people that do the urine observations are onto the whizzinator. They see them all the time. It's easier for women because we can store it internally, which makes it the correct temperature and harder for the observer to see. I hope this helps. If anyone has any questions, I will try my best to give the most accurate information available.

That is some very insightful information that you've contributed. It's great to have a practicing health professional join this discussion board.
I am surprised to hear that you've seen tramadol show up as an opiate on a tox screen since it is not actually an opiate derivative but rather a fully synthetic "narcotic-like" substance. Obviously, if the screen is testing specifically for tramadol's metabolites, it would show positive but I haven't ever seen it show up on the typical 5-12 panel UA's.
Is this a new screening procedure in your ER lately?

That is some very insightful information that you've contributed. It's great to have a practicing health professional join this discussion board.
I am surprised to hear that you've seen tramadol show up as an opiate on a tox screen since it is not actually an opiate derivative but rather a fully synthetic "narcotic-like" substance. Obviously, if the screen is testing specifically for tramadol's metabolites, it would show positive but I haven't ever seen it show up on the typical 5-12 panel UA's.
Is this a new screening procedure in your ER lately?

It's not really new. I've been seeing Tramadol come back as opiates for a few years now. When I questioned our lab about it, their response was that while labeled non-narcotic, there are trace amounts of synthetic opiates in the drug, hence the positive. Perhaps because we are a hospital and when people come in we need to have a really good idea of what they've taken (they don't usually tell us the truth), we use some ultra sensitive tests? A good friend of mine is in a nurse monitoring program right now for diverting narcotics from work, and she takes Tramadol and has tested positive for opiates repeatedly.

No surprise that many patients at an ER intake would tend to be less than forthcoming about the details of their drug ingestion. I've worked with overdose follow-ups who still insisted that they had only had an adverse reaction to antibiotics.
I'm assuming you are describing tramadol often showing up as an opiate on a UA versus a blood tox screen. The reason I'm surprised is my experience has been that these fully synthetic opioids like tramadol, fentanyl, even methadone always require specific panels for testing beyond the typical UA screens.
One reason I'm aware of this is an ongoing argument I've had with administrators at CDL and DOT testing facilities who screen long-haul truckers, bus dirvers, EMTs, etc. Their urine tests do not screen for these powerful synthetic opioids and, thus, we can end up with school bus drivers on 150mg of methadone/day or a semi-tractor trailer driver wearing 100mcg fentanyl patches. Tramadol doesn't show up on these tests either that I know of.
Also, I'm curious about your nurse friend who is in a drug diversion program for health professionals. Is her painkiller use prescribed by a physician and does the program give her a pass for tramadol?

Stupid question but very paranoid. When doing urine test will one test positive for simple benzo or will it narrow down to the exact med? Always thought there was a 4 day rule and now I'm reading up to 90!
Another stupid question, is Ambien considered to be a benzo?
In the last several months I have taken lortab, morphine, percocet, vistaril and ambien all WITH prescription.
I have an old script for alprazolam (from last February). I have taken multiple benzos including klonopin and Valium WITHOUT a prescription.
I also have scripts for phenergan, Seroquel, zofran, tussicaps, lomotil, pyridium, reglan, potassium citrate and ditropan.

What can I expect if I take a urine drug test within the next 30 days? I think I am obviously okay with the opiates (I had surgery for a kidney stone and spent the night in the hospital and who knows what else they gave me). What about the benzos? Will the one year old script cover everything or should I panic now? Are any of the other scripts I have (like ambien or ditropan) going to show as a benzo and help me pass?

I honestly don't know if I'll even have to take a drug test but I am consistently paranoid and a bit OCD about these things (thus the reason for self medication). If I'm going to be in trouble I think I can form a plan now for the benzo issue as long as it just shows positive for generic benzo and not all of the types I take.

While on the topic, which benzo is best to take to get out of your system the fastest?

That is some very insightful information that you've contributed. It's great to have a practicing health professional join this discussion board.
I am surprised to hear that you've seen tramadol show up as an opiate on a tox screen since it is not actually an opiate derivative but rather a fully synthetic "narcotic-like" substance. Obviously, if the screen is testing specifically for tramadol's metabolites, it would show positive but I haven't ever seen it show up on the typical 5-12 panel UA's.
Is this a new screening procedure in your ER lately?

I was subjected to numerous 5 panel (and later on, 12 panel) drug tests (UA's) at my last job, all the while taking tramadol. This was over the course of several years. I never tested positive for opiates or anything else, for that matter. I'm guessing that UA's performed at hospitals are more sensitive?.... not sure. I do know that at my local ER, they test for drugs in the blood, not in urine.

It depends on what type of test it is? Can you use synthetic urine, buying it online, and then heating it up to temp. with charcoal activated hand warmers? Ambien, and those other night time meds, only stay in your system, for a day, after the effects wear off. Ativan would be the benzo that stays, in your the system the least. Email me if you have any questions. I'm not an expert.

If I am positive will it be for Xanax or just a benzo. If just a benzo then my year old script should also be good for that.

One more question...any idea how long Tramadol hangs around just in case it does show? I've come off of that completely just in case.

I'm a female and would prefer to not cheat. I think if I know what to expect then I can get valid scripts for everything considering all of the crap I've been through over the last 6 months...kidney stone surgery, job loss, beloved dog dying, huge medical bills. Obviously a benzo should not be terribly difficult to obtain legally...just need to know facts. Good Lord I think these posts alone are a good indication of my ongoing anxiety levels. I have been seaching for a therapist that works with an MD since I probably need meds but I really need a grief counselor and those seem to be hard to find even though I have really good insurance. Most don't accept insurance at all and with $7000 in med bills between me and the dog, I just can't pay full price right now.

At my former place of employment, positive results were immediately sent off to a lab for GC/MS testing. That type of test will show the exact benzo being used, if one tested positive for benzos on a UA. I'm not sure if your results will be sent to a lab for further testing (if you test positive) @c729, but it is something to consider.

My former place of employment did on-site drug-testing (unknowingly to us) the day we filled out our paperwork, like tax forms.
On the discovery that I would be required to take a "pee test," I panicked, knowing that I have a "shy" bladder. I drank and drank and drank from that water fountain. I took the test, and "failed" ie tested positive for amphetamines. Fortunately for me, I am prescribed Adderall, so I simply had to bring in my prescription bottle and wait almost two weeks for the more accurate tests to come back.
However, later on, I realized that I had, in fact, taken several puffs of marijuana (which I barely ever smoked) earlier that day when my roomie was passing the bowl around.
Anyways, I am still flabbergasted to this day how in the heck did I pass that test.

Does anyone know if Ambien shows up in a urine drug test? I didn't think sleeping pills would show up because a lot of people are prescribed every year and if you take it to sleep it should be out of your system by the time you wake up right? I know when I take it for the "high" it only last a few hours then I feel back to normal so I figure it's already out of my system by the next morning. I've also heard it will show up as a false positive is there any truth to this?

Not unless they are specifically looking for it. The standard tests that they use look for morphine metabolites and benzos. On many of these tests, even they synthetics like hydrocodone don't show up, much less things like Ambien that are not as widely abused.

I think you'd be fine, but if you're worried I'd skip a couple of days before your test. Ambien has a very short half life, so it will be out of your system much faster than the benzos (xanax, klonopin, etc.).

urinalysis question

do urinalysis actually tell if you take more or less than your actual daily dose of suboxone? i'm suppose to take 16mgs a day, ive only been taking 4 to 8 a day, should i dose up real good before my test in 2 days?

My name is Ryan Cope and my company sets up and manages laboratories across the country focusing on toxicology. I could be a good resource if anyone has questions related to drug testing. Maybe my way of giving back to the community for all the valuable info I get from here. I won't feel as guilty feel free to PM or ask any related questions.